1. Posture stability and Balance

2. Posture Principles Definition of “good” posture
Examples of poor posture

3. Posture
Inherent to concept of posture are alignment and muscle balance
Good mechanics require that joint ROM be adequate, but not excessive
The more flexibility, the less stability
The more stability, the less flexibility
Why do only some people get pain?
Posture may be faulty, but individual has mobility so position can change readily
Posture may appear good, but mobility lacking so position cannot change readily

4. Mechanical Imbalance
An alteration of structure and function which is reflected in combinations of muscle tightness and weakness, ligamentous laxity and/or poor alignment of body segments

5. Posture - Principles
Faulty alignment results in undue stress on bones, ligaments and muscle
Adaptive shortening can develop in muscles that remain in a shortened condition
Stretch weakness can occur in muscles that remain in elongated conditions

6. Mechanical Imbalances
Kyphosis-lordosis posture
Flat back posture

7. Kyphosis-Lordosis Posture
increased lumbar lordosis, promotes a forward pelvic tilt and a slightly flexed position of the hip
Leads to increased stress on L4L5 disc and facets and the sacroiliac (SI) joints
cause early recruitment of the lumbar extensors
increased knee flexion at heel strike increasing the potential for patellar tendon and patellar femoral joint injuries

8. Posture types
Normal sway Kyphotic flat

9. Kyphosis-Lordosis Posture
Head – forward
Cervical spine – hyperextended
Scapulae – abducted
Thoracic spine – increased kyphosis
Lumbar spine – increased lordosis
Pelvis – anterior tilt
Hip – flexed
Knee – slightly hyperextended
Ankle – slight plantarflexion

10. Kyphosis-Lordosis Posture
Elongated and weak
Neck flexors, upper ES, external obliques
Elongated, may be weak
hamstrings
Short and Strong
Neck extensors, hip flexors
Strong, may be short
Lumbar ES

11. Posture

13. Flat-back Posture Head – forward Cervical spine – slightly extended
Thoracic spine – upper increased flexion; lower straight
Lumbar spine – flattened (flexed)
Pelvis – posterior tilt
Hip – extended
Knee – extended
Ankle – slight plantar flexion

14. Flat-back Posture Elongated and weak Strong, not short
One-joint hip flexors Short and Strong
Hamstrings, upper fibers of internal oblique
Strong, not short
Lumbar ES

15. General population
Swayback: Approximately 30% of men and 20% of women.
Kyphosis-Lordosis: Approximately 20% of women and 15% of men.
Flatback: Approximately 10% of men and women.
Only 5% of persons may have the optimal posture depicted to the left, with a further 15% coming reasonably close

16. Summary
Postures that deviate from ideal can produce adaptive shortening, strengthening, elongating and weakening that can affect structures quite distal to the poor posture culprit
Use a postural assessment to guide your specific assessment and treatment plans, especially for chronic, non-traumatic problems

18. Regaining postural stability and balance
“CoG” is located just above your pelvis. In order to remain “balanced”, your CoG must remain within the limit of stability “LOS”.
“balance” is the ability to maintain the body’s segments in alignment within a “limit of stability” (LOS).
Balance is the single most important element dictating movement strategies with in the closed kinetic chain.

20. Regaining postural stability and balance
Is both
Static
Dynamic
Dynamic for example, walking, climbing stairs, etc

21. MOVEMENT STRATEGIES
What are the 3 movement strategies that are used by the body to maintain the CoG within a stable base of support?
1. ankle
2. hip
3. stepping

22. MOVEMENT STRATEGIES When would each strategy be used?
Ankle: when small, slow movements, close to CoG
Hip: larger, quicker movements required. Also if CoG gets closer to LOS.
Stepping: if CoG gets out of Limit Of Stability.

23. INJURY AND BALANCE
Studies of the knee and ankle show that there is a decrease in proprioceptive feedback from damaged ligaments to the CNS (sensory/afferents).
Therefore, is decreased reflex excitation of motor neurons (efferents) to the muscles responsible for preventing sway/controlling balance.

24. BALANCE TRAINING
MUST improve the balance and postural equilibrium of the athlete in order for them to return safely and effectively to the playing field.

25. BALANCE TRAINING
General rules when developing a balance training program:
Exercises must be safe, yet challenging
Stress multiple planes of motion
Incorporate a multi-sensory approach
Begin with static, bilateral, stable. Progress to dynamic, unilateral, unstable.
Progress to sport-specific
Multiple planes of motion – flexion vs extension, adduction vs abduction
Multisensory approach – eyes open vs eyes closed
Begin with static, bilateral, stable. Progress to dynamic, unilateral, unstable.
Various surfaces – wobble boards, pillow, trampoline, etc
Sport specific exercises are always done last

26. BALANCE TRAINING CLASSIFICATIONS OF BALANCE TRAINING/EXERCISES
1. static:
2. semi-dynamic:
3. dynamic:
4. functional:

27. BALANCE TRAINING static:
CoG is maintained over fixed base of support on a stable surface.
i.e. Rhomberg tests

28. 2. semi-dynamic: 2 types
(a) maintain CoG over fixed base of support while on moving surface or unstable surface (BAPS/Wobble board)
(b) transfer CoG over a fixed base of support to areas within the LOS while standing on a stable surface (pick up pens)

29. BALANCE TRAINING 3. dynamic:
CoG maintained within the LOS, while over a moving base of support on a stable surface.
Requires a stepping strategy
i.e. hopping, walking on a balance beam
More into plymetics – hopping, climbing, jumping, up stairs, down stairs, etc
Ex dynmaic test for basketball player – shuffle side to side on their own
Functinal/sport specific – have the basketball player mimic the motions of the trainer

30. Balance Training 4. functional:
same as dynamic, except also have sport specific tasks included.
i.e. catching/throwing a ball while running.